Looking at the current plastic surgery-palooza, one can't help but wonder: whatever happened to the Hippocratic oath, anyway?

Writes Ruth Fowler, an expat residing in L.A., in the Huffington Post,

The amount of women, like Heidi, I see in Los Angeles walking around like blow up dolls, victims to the horrific mental disorder of body dysmorphia — is huge. Body dysmorphia is as much as a disease as anorexia, as bulimia, as over-eating, as alcoholism, drug addiction. These are mental disorders which manifest themselves in physical self-harm. I fail to see how embarking on eleven different surgeries in one day, nearly dying from too much Demerol, and emerging, afterwards, with a nose which looks perfect but could drop off at any second, and boobs which prevent you from sleeping, moving and exercising — how can this not be defined as causing massive injury to the patient? If Dr. Ryan had cared so goddamn much about Heidi, he wouldn't have warned her DDD was too big — he would have flat-out refused to have given her the operation. Like so much of the unregulated US healthcare system, damage to the patient isn't a priority. Of course a plastic surgeon wouldn't refuse a Hollywood starlet, because he wants the cash and he wants the exposure. He's running a business. Privately, he may care she's doing damage to herself — but he doesn't care enough to stop.

Of course, the late Dr. Ryan — and for that matter, Montag herself — are, perhaps, extreme cases. At the very least, extremely visible. But by the same token, they might stand as a visible reminder of things that go on, every day, without attracting notoriety or concern. When does limiting personal choice become paternalistic? How do we define "harm?"

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As the author points out, in no other branch of medicine can a patient impose his medical opinion to the same degree (lest the hypochondriacs run the asylum); why is plastic surgery so different — at least legally? ("Board certification" doesn't seem to mean as much as some authorities would wish; some politicians have pushed for further legislation — but even this concerns the conditions of the clinics and doctors' qualifications rather than the ethics of the business.) At the very least, it seems like mandatory psychological evaluation should be a larger part of the process. Because the sad truth is, if Ryan hadn't performed Montag's notorious ten operations, someone else would have. And "nearly dying" could have been a grim reality.